R 2016-122 Aging - UNC at Chapel Hill for physical therapy assessments

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ORANGE COUNTY-DEPARTMENT USE ONLY /'% / 10 Department Party/Vendor Name: University of North Carolina at Chapel Hill Party/Vendor Contact Person: Valerie Tan Contact Phone: 919-843-4828 Party/Vendor Address: Allied Health Sciences,CB 7120 City Chapel Hill State: NC Zip: 7599-7120 Department: Aging Amount: $12,000 Purpose: physical therapy assessments Budget Code(s • 9430320-630000 Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant? Yes[:1 No❑ Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective Date 05/01/2015 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to technical form and content: Department Director's Signature Date: /-,2o•16 Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards, specifications,and requirements: Office of the Risk Management Officer—z2&__ AO — Date: / l h Financial Services This instrument has been pre-audited in the m er r quired by t e Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer Date: Legal Services This agreement is approved as to legal fo d s cy: Office of the County Attorney Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd a,oran ecountync.eov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: